Global Health Day robert j. havey, md institute for global health

December 1, 2023

Thank you for joining us!

The Havey Institute for Global Health's annual Global Health Day event is an exciting opportunity to draw together global health researchers, educators, and students to celebrate and discover more about global health research, education, and outreach efforts throughout our Northwestern community, Chicago, and beyond.

The event includes a poster and presentation showcase where students, faculty, community members and partners present on projects relevant to global health. You can view the posters and abstracts below. (Abstracts are listed alphabetically by first initial of first name of participant who submitted.)

Global Drug Overdoses: The Relationship Between Death Rates and Socioeconomic Factors

Background: The number of people dying from drug overdoses continues to increase year over year. However, there is great variation in drug overdose death rates by country and a global analysis could reveal numerous factors that may play a role in deaths due to drug overdose. Objective: The purpose of this analysis is to aid policymakers in understanding how country-level variables, such as policies, corruption, and poverty, interact with drug overdose death rates. Methods: We reviewed global data sources on drug overdose death, production, decriminalization, trafficking, and treatment. We also looked at non-drug-related variables such as corruption, crime, and poverty on the country level.

Presenting author: Akshya Dhinakaran

Poster 1

Middle East and North Africa Surveillance Metrics and History of the COVID-19 Pandemic: Updated Epidemiological Assessment

Background: This study updates the COVID-19 pandemic surveillance in the Middle East and North Africa we first conducted in 2020 with two additional years of data for the region. In addition to updates of traditional surveillance data and dynamic panel estimates from the original study Post et al. (2021), this study used data on sequenced SARS-CoV-2 variants from the Global Initiative on Sharing All Influenza Data (GISAID) to identify the appearance and duration of variants of concern. We used Nextclade nomenclature to collect clade designations from sequences and Pangolin nomenclature for lineage designations of SARS-CoV-2. Finally, we conducted a one-sided t-test for whether regional weekly speed was greater than an outbreak threshold of ten. We ran the test iteratively with six months of data from September 4, 2020, to May 12, 2023.

Presenting author: Alan Soetikno

Poster 2

Seeking Care for Mental Illness: Comparing the All of Us Research Program and the SAMSHA Cohort

Background: Since 2018, the All of Us Research Program (AoURP) has been dedicated to building a diverse health database by focusing on recruiting Underrepresented in Biomedical Research (UBR) populations. Understanding UBR populations' level of access and utilization will allow for better distribution of mental health resources. We will be analyzing how AoURP's data on participants who have sought mental healthcare compares to another national database– SAMSHA's 2020 report on Mental Health Client-Level Data. Due to varying recruitment efforts and timing of data collection, we expect the two databases will be statistically different.

Presenting author: Amritha Kumar

Poster 3

Approaches for Identifying, Engaging, and Supporting Champions in Implementation Science in Cancer Prevention and Control

Background: Champions have long been utilized in evidence-based intervention (EBI) implementation to promote adoption and sustainability of health initiatives and mitigate barriers to care for underserved and marginalized populations in various settings. The use of champions as key drivers of effective EBI implementation is relevant across different healthcare systems and cultural contexts. Despite their importance in the global community and clinical implementation of EBIs, little has been written about how to identify, engage, and support champions in cancer-related implementation science. Objective: Our study fills these literature gaps by delineating how effective cancer-related implementation science projects selected champions, outlined champion responsibilities, and supported champions in their roles.

Presenting author: Andre Victor Oliveira Avellar

Poster 4

Virtual Immediate Feedback with POCUS in Belize

Point of care ultrasound (POCUS) is a portable and accessible tool that has immense potential in low- and middle-income countries (LMIC) for diagnostic accuracy and medical education. We implemented a hybrid in-person and virtual training curriculum to teach providers in Belize the basic techniques of lung ultrasound in the diagnosis of pneumonia. We provided a handheld Butterfly iQ+(™) ultrasound device to a primary care clinic through a collaboration with Northwestern University and Hillside Healthcare International Clinic. Between August 2021 and June 2022, a total of eleven lung scans were performed at Hillside Clinic for patients presenting with respiratory complaints. Deidentified images were shared via the ButterflyIQ web platform to POCUS experts in the United States. We found that training was solidified through virtual, immediate feedback using the common interfaces Butterfly iQ+ and WhatsApp to share images and guide diagnostic reasoning. The aim of this review study is to share our experience and challenges in the implementation of a POCUS training curriculum in an LMIC, provide an example of training methodology that can be effective, and discuss how this can be implemented and modified for clinicians in similar settings.

Presenting author: Anita Mulye

Poster 5

Click to enlarge poster 5

Promoting Eye Health among children and adults through Community Health Workers using a smartphone application : A Pilot Project in Dandora, Kenya

Introduction: Visual impairment is a global health challenge especially in countries where screening is limited. Over 80% of blindness in Kenya is due to preventable causes. An estimated 620,000 Kenyans need eye care services. Identifying at-risk patients in the community and screening them for treatable eye conditions can help bring those with visual impairment into the healthcare system to receive appropriate management. Leveraging the community and primary care systems can be sustainable. Objectives: 1. To assess the feasibility and effectiveness of community health worker (CHW)-delivered screening using the PEEK smartphone application to children aged (9 to 17 years) and adults (18-to 50 years). 2. To understand the burden of impaired vision among those screened and the success in linking to assessment and access to corrective lenses within 4 weeks of screening.

Presenting author: Anjum Koreishi

Poster 6

TISTool: Webtool for Transposon Insertion Sequencing Data Analysis and Visualization

Transposon Insertion Sequencing (TIS) has become an increasingly valuable technique in microbial genomics, necessitating the development of sophisticated and intuitive software for the analysis of TIS data. We introduce TISTool, a web-based platform conceived to overcome the shortcomings of pre-existing TIS data analysis pipelines. Conventional TIS analytical tools are hampered by several limitations: command-line-only interfaces, inadequate quality control parameters, and a deficiency in advanced normalization and statistical algorithms. These limitations can hinder their utility, compromise the integrity of the results, and diminish the reliability of the subsequent interpretations. TISTool is developed to address these challenges by refining the ESSENTIALS analysis framework and broadening its compatibility to accommodate a spectrum of TIS methodologies. It incorporates stringent quality control mechanisms for both raw data and subsequent gene counts, a suite of sophisticated statistical models, and a comprehensive selection of interactive visualization tools, enabling thorough analysis of TIS datasets. Currently, in active development, the Beta version of TISTool is accessible at, signaling ongoing enhancements and offering a valuable resource for the advancement of bacterial genetics research.

Presenting author: Arghavan Alisoltani

Poster 7

Facilitators and Barriers in Scaling-up Intensive Combination Approach to Rollback the HIV Epidemic in Nigerian Adolescents (iCARE)

Background: Youth living with HIV (YLWH) are disproportionately impacted by HIV with poor outcomes along the entire HIV care continuum including testing, linkage to care, and virologic control. A 2020-2022 pilot study, iCARE Nigeria, tested a combination intervention incorporating mobile health technology and peer navigation using parallel approaches to: 1) improve testing and linkage to HIV care for young men, especially YMSM via social media outreach (testing arm), and 2) to improve medication adherence and treatment outcomes for youth enrolled in HIV care via two-way SMS reminders (treatment arm). The 12-month pilot study demonstrated effectiveness, feasibility and acceptability in both arms. The intervention was scaled up to 5 additional sites in 3 Nigerian cities. Advancing from pilot sites to scale-up is often challenged by new environments and staff. Our objective was to understand scale-up site implementers' perspectives on feasibility, readiness for adoption, and potential facilitators and barriers soon after iCARE scale-up.

Presenting author: Arthi Kozhumam

Poster 8

HPV Typing in Cervical Cancer Screening Among HIV-Positive Women in Mali

Cervical cancer is the 4th most common cancer in women worldwide. In Mali, it ranks second among women and has a high incidence and mortality rate. High-risk human papillomavirus (HPV) infection is the primary risk factor. We conducted a one-year prospective cross-sectional study as part of the D43 project, involving 100 HIV-positive participants in Bamako, to assess HPV typing in cervical cancer screening. We collected data via survey forms and obtained vaginal swabs through self-sampling. GeneXpert technology was used for typing. The study found a 40% infection prevalence. The majority of participants were aged ≥40 years (65%), with a mean age of 43.97 ± 9.54. The average age at first sexual intercourse was 16.52 ± 6.33. Most participants were multiparous (87%), and the majority preferred self-collection at the center (92%). HPV subtypes 18 and 45 were the most detected (25.35% each), with 18/45 co-infection being the most common (25%), followed by P5 (20%). Infection was more prevalent in participants aged ≥40 years (P=0.087), multiparous women (P=0.627), those with low literacy levels (P=0.677), and women with a history of STIs (P=0.774). Cervical cancer is a significant issue in our population. HPV typing via self-sampling can be an effective approach to achieving the WHO 90-70-90 target.

Presenting author: Brehima Diakite

Poster 9

Disparities in Pediatric Healthcare Access Among Femur Fracture Patients

Intro: Spica casting is one of the most common immobilization methods for pediatric femur fractures worldwide. Previous studies have explored the burden of care and other topics related to spica casting of pediatric femur fractures. However, the impact of social determinants and potential disparities in this area is unknown. Our study aims to investigate differences in presentation and course of treatment for children undergoing spica casting of a femur fracture with respect to insurance and race/ethnicity. Methods: This is a single-center retrospective cohort study at an urban tertiary children’s hospital. Patients under the age of 5 years who underwent closed reduction and spica casting of a diaphyseal femur fracture in the operating room were included. We excluded patients older than 5 years, those with fractures in the metaphysis or epiphysis, or who required open treatment and/or implants. Injury characteristics, demographics, and treatment course were recorded. Univariable analysis was followed by multivariable regression to adjust for confounders.

Presenting author: Bryce Maxwell

Poster 10

Population Genomics to Understand Antimicrobial Resistance in Pseudomonas aeruginosa

Population Genomics to Understand Antimicrobial Resistance in Pseudomonas aeruginosa. Claudia E. Oropeza, Sophia Nozick, Alan R. Hauser, Egon A. Ozer. Abstract: Background: The global burden of antimicrobial resistant bacteria is one of the most urgent public health concerns. Pseudomonas aeruginosa (PA) is a gram-negative opportunistic pathogen that is commonly associated with nosocomial infections. Eradication has become progressively difficult due to the bacteria's remarkable ability to become resistant to antibiotics over time. Moreover, the World Health Organization (WHO) has declared carbapenem resistant PA to be one of the bacteria for which development of new antibiotics is of the highest priority. Advances in technology such as genomic surveillance have provided new insights into resistance mechanisms in bacteria; however, there is a gap in knowledge between genotypes and resulting phenotypes that confer resistance in PA. Currently there is a lack of high-quality genomic DNA sequence data from strains with known antibiotic susceptibility. Therefore, we sought to perform whole genome sequencing of PA isolates and examine the population genomics for elements contributing to PA's rapid adaptation to carbapenem resistance. Identification of novel targets can be used as therapeutic treatments to address this unmet need.

Presenting author: Claudia E. Oropeza

Poster 11

Interdisciplinary Intervention to Reduce Poverty and Undernutrition in Southwestern Uganda: The Rabbit Breeding Project (A Case Study)

According to the most recent Demographic and Health Survey (DHS), thirty three percent of children in Uganda under the age of five are stunted (have low height-for-age) and four percent are acutely malnourished or wasted (low weight-for-height) . Drivers of malnutrition in Uganda are multifactorial and include lack of access to clean water and sanitation, high childhood disease burden of diarrhea and malaria, poor infant feeding practices and food insecurity as a result of poverty, landlessness, natural disasters, and high food prices . Household poverty and poor nutrition are longstanding barriers to receiving Primary Health Care (PHC) services in Southwestern Uganda. Social and economic changes over the past few years have led to an increased interest in rabbit meat products. Rabbit meat is highly nutritious, notable for its high protein content, low percentage of fat and cholesterol, and caloric content similar to chicken. The ease of rabbit care due to availability of feed from local foliage, low rate of disease, use of waste as valuable fertilizer and short gestation period with prolific breeding allows for the potential for rabbits play an important role in the population health, rural economy, and sustainable development in Uganda.

Presenting author: Danielle Steker

Poster 12

Molecular Epidemiology of SARS-CoV-2 in Bolivia

Since its emergence in 2019, SARS-COV-2 has infected millions of individuals during the global pandemic. Since then, health officials and scientists globally have found several advantageous evolutionary changes that allow for the virus to have increased transmission, immune escape, and drug resistance. Much of our understanding of variants of concern (VOC) and their emergence is heavily dependent on the genomic surveillance of COVID cases around the world. However, most reported COVID cases and genomic surveillance data are largely provided by economically advantaged regions such as Europe, North America and Asia; resulting in distribution leaves gaps in global SARS-COV-2 surveillance, most notably in low- and middle-class countries such as Peru, Bolivia, and Nigeria. In under sampled regions where different ecological pressures and vaccine requirements exist the virus has unique opportunities for new variants to emerge and remain undetected.

Presenting author: Dulce Garcia

Poster 13

Assessment of Hospitals Readiness in Implementing a Non-Technical Skills for Surgery Training Program, a Cross-Sectional Study

Background Non-technical skills for Surgeons (NOTSS) are essential for safe intraoperative patient care. A NOTSS training program addressing the resource variability context has been developed and taught to surgical care providers from Rwanda. Past NOTSS course participants recommended providing the NOTSS course to all people involved in surgical care delivery. This would require a more tailored intervention that can be implemented alongside existing quality improvement and surgical safety initiatives. The aim of this study was to evaluate the perceptions of surgical teams and hospital leadership on the feasibility of implementing a NOTSS training program at their institution. Methods We conducted a cross-sectional study; surgical care providers (surgeons, general practitioners, anesthesia providers, and perioperative nurses) were invited to participate in a two-hours NOTSS refresher course. Immediately after the course, participants were asked to take the paper-based Safe Surgery Organizational Readiness Tool (SSORT). The SSORT uses a five-point Likert scale to assess hospital readiness on 56 items that are grouped into 16 domains. Each SSORT domain has two to five questions. Domain scores were calculated by averaging the scores of its items. We also dichotomized the score f the domains; and for each domain, participants were satisfied if they responded that they strongly agree or agree with all questions under that domain. Descriptive statistics were used to summarize participants and hospital characteristics. Multivariable logistic regression models accounting for participants clustered into hospitals were used to assess the relationship between participants and hospital characteristics with SSORT domains.

Presenting author: EGIDE ABAHUJE

Poster 14

Transitioning to adult care of adolescents and youth living with HIV in low-income settings; experiences from the perspective of health care workers, managers, and parents/caregivers

Introduction: Young people living with HIV, whether perinatally or behaviorally acquired, due to their vulnerability face numerous clinical and psychosocial challenges such as neurodevelopmental disorders, organ diseases, growth retardation (stunting) and mental disorders that may directly influence their clinical outcomes, functionality, and quality of life. These challenges may hinder their resilience, independence, and confidence from transitioning to adult care. Without a comprehensive intervention to prepare young people to be responsible for their health, there may be an increased risk for HIV morbidity and mortality while in adult care. AIM: To explore the experiences, including barriers and facilitators of health care providers and parents/caregivers in advocating successfully transitioning of adolescents and youth from pediatric to adult HIV care.

Presenting author: Fileuka Ngakongwa

Poster 15

The counseling practice for chronic diseases in primary healthcare centers in Abuja, Nigeria: a cross-sectional formative assessment

Background: Diabetes is a non-communicable disease (NCD) of public health importance. Implementing diabetes control programs in Primary Healthcare Centers (PHCs) is essential to mitigate the rising prevalence of diabetes and diabetes-attributable death in Nigeria. Objective: To determine the PHC's chronic disease counseling practices, strengths, and weaknesses as part of capacity and readiness assessment to inform successful diabetes control programs at the selected PHCs in Abuja, Nigeria. Methods: This was a cross-sectional formative assessment conducted in 30 public PHCs in Abuja, selected by a multi-stage sampling technique. The data were collected from August to October 2021 using the World Health Organization's Service Availability and Readiness Assessment tool adapted to assess the availability of essential inputs required for diabetes screening and management, including educational materials and chronic disease counseling services. The team interviewed consenting senior staff and heads of units at the PHCs and observed operations, equipment, medications, materials, and supplies during the site visits. The results were reported as the proportion of the PHCs with available educational materials and counseling services for patients with chronic diseases and self-management training for chronic disease patients. Data were analyzed using R version 3.5.1 (R Foundation, Vienna, Austria) and Microsoft Excel version 2016.

Presenting author: Ikechukwu Anthony Orji

Poster 16

The prevalence of metabolic syndrome and associated factors among adults Living with HIV in Tanzania on Dolutegrtavir containing ART

Background Adults living with HIV (PLHIV) are at an increased risk of developing metabolic syndrome. Anti-retroviral drugs, such as protease inhibitors and nucleoside reverse transcriptase inhibitors, have been associated with an increased risk of metabolic syndrome. Limited evidence exists on the impact of new drugs, such as dolutegravir, on metabolic syndrome in sub-Saharan Africa where the burden of HIV and other cardiometabolic risk factors is high. Objective The objective of this study was to assess the prevalence of metabolic syndrome among ALHIV on a Dolutegravir-based regimen in Tanzania. Methods This was a retrospective cross-sectional study among ALHIV aged 18 and above in Dar es Salaam, Tanzania. Secondary data was obtained for a cohort of ALHIV who participated in a prior study of cardiovascular health conducted in six randomly selected, high-volume Care and Treatment Clinics (CTCs) Dar es Salaam between November 2020 and January 2021. Demographic, healthy-lifestyle-related risk factors data, anthropometric measurements, data on blood pressure, blood glucose, and lipid profile were collected.

Presenting author: Innocent Yusufu

Poster 17


Objective: Cardiovascular diseases are a leading cause of the noncommunicable disease burden in Mali. The HEARTS technical package of the World Health Organization (WHO) is a multi-level approach toward integrating cardiovascular services into primary care. This study sought to provide consistent and reliable information about availability of basic equipment, essential medicines, and diagnostic capacity for hypertensive services in 3 health care centers in Bamako, Mali. Methods: From December 2021 to January 2022, data were collected from 3 health facilities in Bamako, Mali (2 regional referral hospitals, 1 tertiary care facility) using an adapted version of the WHO Service Availability and Readiness Assessment (SARA) instrument to assess key indicators to gather data on capacity and site readiness for HEARTS implementation. Summary data are reported as means and proportions, as appropriate, with statistical comparisons across the sites using a one-way analysis of variance.

Presenting author: Issiaka Camara

Poster 18

Relationship Between TP53 PIN3 16-bp Duplication and HPV Typing in Cervical Cancer Screening Among Women Living with HIV/AIDS in Mali

TP53 polymorphisms have the potential to impact the immune response against HPV, affecting TP53's ability to regulate the cell cycle and induce apoptosis, which are critical mechanisms for controlling HPV infection and preventing cancer development. This study aimed to examine the relationship between PIN3 16-bp duplication polymorphism of TP53 gene and HPV infection in HIV-positive women in Mali. In this prospective cross-sectional study, 50 HIV-positive women from Bamako, Mali, were enrolled. Data collection involved survey forms, self-sampling for vaginal swabs, and blood collection. HPV typing was performed using GeneXpert technology, while genotyping of the PIN3 16-bp duplication polymorphism was conducted using AS-PCR.

Presenting author: Kadidiatou Cisse

Poster 19

"A man has the right to beat his wife:" Evidence on intimate partner violence, protective policies, and women's empowerment in Kenya

Intimate partner violence is a recognized global health problem that spans countries, cultures, and classes. According to estimates by the World Health Organization (WHO), roughly 30% of women worldwide have been subjected to physical and/or sexual violence by their partner (2021). Accordingly, the WHO has characterized this issue as a "global health problem of epidemic proportions" (2013). Survivors of intimate partner violence suffer health consequences (ranging from anxiety and depression to physical injuries to unintended pregnancies to homicide) as well as economic and social consequences (such as loss of wages and isolation). Unfortunately, COVID-19 lockdowns in recent years have further exacerbated gender-based violence by increasing women's exposure to abusive partners (WHO 2020). There exists a pressing need to address this growing public health issue that impacts one in three women. Due to social desirability bias, rigorous evidence documenting the extent of the problem and evaluating interventions to curb intimate partner violence is difficult to obtain. This project leverages unique survey experiments that overcome this bias, revealing attitudes towards intimate partner violence and the impact of policies to prevent gender-based violence.

Presenting author: Kelly Hunter

Poster 20

Molecular Epidemiology of Human Mpox in Chicago

Mpox, formerly known as monkeypox, is a syndrome of fever, rash, and lymphadenopathy caused by the mpox virus (MPXV); a zoonotic double stranded DNA orthopoxvirus. The virus has several animal reservoirs and was first isolated in monkeys from Singapore in 1959. Since its emergence in humans in the 1970's, MPXV has become endemic in central and western Africa with the most cases in Democratic Republic of Congo. In July of 2022, the WHO declared a global outbreak consisting of over 88 thousand cases across 113 countries, largely attributed to human-to-human transmission. Global case counts peaked in early September of 2022 before tapering off in January 2023. In April 2023 a small resurgence of cases was noted in Chicago among individuals that had received at least one dose of the JYNNEOS vaccination against MPXV and smallpox. In this study, we investigated the genetic variation and evolution of the virus throughout the 2022-2023 outbreaks in Chicago.

Presenting author: Lacy Simons

Poster 21

Genomic Surveillance of Antifungal-Resistant Candida auris and Other Yeast in Pakistan: Monitoring Expanding Infections and Uncovering Emerging Pathogens

In recent years emerging fungal organisms such as Candida auris have been associated with outbreaks of infections in hospitals and other healthcare settings. Epidemiologic and molecular surveillance is essential for identifying and characterizing potentially emerging or unusual fungal pathogens. Here we report whole genome sequencing results from 230 fungal isolates cultured from patient infections in Pakistan between 2020 and 2023. Species identification of fungal isolates cultured from patient specimens was performed using the VITEK 2 YST ID card and susceptibility testing was conducted using the YeastOne Sensititre YO10 system in the clinical microbiology laboratory at Aga Khan University Hospital in Karachi. DNA was extracted from each sample and shipped to the Center for Pathogen Genomics and Microbial Evolution at Northwestern University for whole genome sequencing (WGS). Sequencing libraries were prepared using the Seqwell Plexwell kit and sequenced on the Illumina Novaseq Platform. 120 of the sequenced isolates were identified as Candida auris, the remaining isolates belonged to one of 12 other fungal species. Nineteen isolates were identified as Kodamaea ohmeri, an uncommon pathogen most often causing infections in neonates and elderly individuals.

Presenting author: Lacy Simons

Poster 22

Supportive Supervision Visits in a Large Community Hypertension Program in Nigeria: Implementation Methods and Outcomes

Background: The Hypertension Treatment in Nigeria (HTN) program is aimed at establishing a system for blood pressure management in 60 public primary health care facilities in the Federal Capital Territory of Nigeria through the implementation of multi-level strategies including team-based care led by community health extension workers (CHEWs). To improve implementation of evidence-based hypertension care, supportive supervision was chosen as an implementation strategy. Methods: Multidisciplinary supervision teams were formed by research staff, and included primary care physicians, pharmacists, nurses, and data entry officers. The supervision teams received training that emphasized communication, audit and feedback, and joint problem-solving. A structured supervision checklist guided each PHC visit, and captured: staffing, quality of care (blood pressure measurement, medication use, data quality), and equipment and medication availability. During each visit, the supervision teams reviewed performance of the PHC and provided tailored coaching and training to staff on standard methods of BP measurements, treatment protocol adherence and data entry. The RE-AIM framework was used to measure implementation outcomes of the supportive supervision strategy. Results showed high reach, with all PHCs receiving visits annually with most receiving quarterly as planned by Year 3. Visit fidelity increased over time with most sites receiving more than three quarter of components, and the model was feasible and adopted.

Presenting author: Lamkur Gabriel Shedul

Poster 23

Viral amplification from African samples using long-read sequencing

Background: Human Immunodeficiency Virus (HIV) is a retrovirus that establishes a chronic infection that results in acquired immunodeficiency syndrome (AIDS) if left untreated. Current anti-retroviral therapies (ART) are comprised of combinations of drugs that inhibit viral replication to below the limit of detection. ART regimens have significantly increased the life expectancy and quality of life for infected persons, but they are not curative. Upon treatment cessation, the virus rapidly rebounds, mandating lifelong adherence to ART. The source of this rebounding virus is known as the HIV reservoir, and it is comprised by persistent viral populations integrated within the host cell genome that constitute the main obstacle for a successful HIV cure. Increasing evidence indicates that this HIV reservoir has a complex and heterogeneous composition, however its nature and characteristics remain poorly understood. The high mutation rate of HIV remains an obstacle to proper long-read sequencing. Methods: Our research is focused on characterizing the HIV reservoir and intra-host variability using near full-length genome (NFLG) amplification and whole genome deep sequencing. We will analyze intra-host viral diversity including the presence of drug-resistant mutations to understand the effect of suboptimal therapy on the appearance and drug-resistant mutations. This approach is currently being used as a supplement to a titled-amplification approach.

Presenting author: Maryam Shaaban

Poster 24

Developing a palliative care service at Lagos University Teaching Hospital: formative results of an environmental scan of existing centres in Nigeria

Background: Across Africa, less than 5% of people needing palliative care (PC) receive it. In Nigeria, few of the 105 public tertiary facilities offer institution-based PC services, with none being available in Lagos city. We conducted an environmental scan of existing PC centres across Nigeria to characterize the existing PC models and examine patient-centered outcomes under them. These results will inform the establishment of PC services at Lagos University Teaching Hospital (LUTH). Methods: This mixed methods assessment was conducted from February-April 2023 at five PC centres identified in Ilorin, Ibadan, Port-Harcourt, Abeokuta and Enugu cities. Surveys were administered to ≥18 year-old administrators, frontline workers, patients, and caregivers at each centre. Administrator and frontline worker surveys were informed by a checklist developed by the Centre for Palliative Care in Nigeria and the Consolidated Framework for Implementation Research to contextualize Inner and Outer setting, Intervention, Implementation Process, and Individuals Involved. Specifically, information about infrastructure, operations, staffing, training, and patient characteristics were captured through open-ended responses and descriptive statistics. For patients and caregivers, Likert scale surveys based on the African Palliative Care Outcome Scale were used to assess the quality and effectiveness of PC services.

Presenting author: Matt Caputo

Poster 25

Neurologic manifestations of long COVID differ in post-hospitalization vs non-hospitalized patients in Colombia

Background and Objective: Persistent symptoms lasting >3 months after COVID-19 are known as Long COVID or post-acute sequelae of SARS-CoV-2 infection (PASC). We sought to characterize the neurologic manifestations of PASC (Neuro-PASC) among post-hospitalization Neuro-PASC (PNP) and non-hospitalized Neuro-PASC (NNP) patients in Colombia. Methods: We conducted a prospective cross-sectional study of neurological sequelae in individuals with PCR-confirmed SARS-CoV-2 infection. Participants were recruited after initial review of medical records or response to social media advertisements. Those who met eligibility requirements and came for evaluation were included in the study. We now report on the first 66 participants, including 26 PNP and 40 NNP patients evaluated since August 2023 at the Universidad CES Neuro-COVID research unit in Medellín, Colombia.

Presenting author: Natasha Choudhury

Poster 26

Primary Surgical Closure of Neural Tube Defects in Low Income Countries: A Systematic Review

Background: Neural tube defects (NTD) are the most common severe central nervous system malformation, only second to cardiovascular abnormalities, resulting in significant morbidity and mortality. The implementation of mandatory folate fortification programs and fetal surgery have dramatically reduced the burden of NTDs in high resource settings. Yet, prevalence of NTDs in low- and middle-income countries (LMICs) is significant. It is hypothesized that low-income countries (LICs) carry the greatest burden and the surgical management within these countries has not been described. This paper aims to characterize the surgical management of NTDs with LICs. Methods: A systematic review among seven databases (MEDLINE, Embase, Scopus, Web of Science, Global Index Medicus, LILACs, SCIELO) was conducted between inception to October 2023. Studies reporting outcomes of primary NTD closure in LIC were included.

Presenting author: Rya Muller

Poster 27

Social capital influences the availability and effectiveness of household water insecurity coping strategies: Qualitative evidence from female smallholder farmers living with HIV in western Kenya

Background: Household water insecurity (HHWI) is prevalent in sub-Saharan Africa. Recent scholarship demonstrates that greater social capital (SC) may mitigate HHWI, but its role among smallholder farmers experiencing agricultural water challenges remains underexplored. Further, while studies have documented barriers to accessing critical resources among persons living with HIV, the role of SC in addressing HHWI within this population is understudied. Objective: We qualitatively explored how an agricultural intervention (treadle water pump) might influence SC and the link between SC and HHWI coping strategies (CS) affecting agricultural production. Method: We recruited participants in 2018 from a randomized agricultural intervention (NCT02815579) that provided irrigation pumps to improve the health and economic well-being of smallholder farmers living with HIV in western Kenya (n=42). Participants were asked about their experiences with HHWI in Go-Along and photo-elicitation interviews. Transcripts were analyzed thematically using inductively developed codes.

Presenting author: Samanvi Kanugula

Poster 28

Canadian Surveillance Metrics and History of the COVID-19 Pandemic: Update of Epidemiological Assessment

Background & Objective: This study provides an update to the status of the COVID-19 pandemic in Canada building upon our initial analysis conducted in 2020 by incorporating an additional two years of data. Similar studies of other global regions including the neighboring United States have been conducted in parallel, allowing for international comparison of various pandemic-related metrics and histories. First, we aim to summarize the status of the pandemic in Canada when the World Health Organization (WHO) declared the end of the public health emergency for the COVID-19 pandemic on May 5, 2023. Second, we use dynamic and genomic surveillance methods to describe the history of the pandemic in Canada and situate the window of the WHO declaration within the broader history. Third, we aim to provide historical context for the course of the pandemic in Canada. Methods: In addition to updates of traditional surveillance data and dynamic panel estimates from the original study Post et al. (2021), this study used data on sequenced SARS-CoV-2 variants from the Global Initiative on Sharing All Influenza Data (GISAID) to identify the appearance and duration of variants of concern. We used Nextclade nomenclature to collect clade designations from sequences and Pangolin nomenclature for lineage designations of SARS-CoV-2. Finally, we conducted a one-sided t-test for whether provincial and territorial weekly speed was greater than an outbreak threshold of ten. We ran the test iteratively with six months of data across the sample period.

Presenting author: Scott A. Wu

Poster 29

Comparative Analysis of Healthcare Access among the All of Us Research Program: Underrepresented Biomedical Research populations (UBR) vs Represented Biomedical Research populations (RBR)

Involvement of underrepresented groups in outcomes research is crucial in mitigating healthcare disparities. However, effectively engaging these groups poses significant challenges, and neglecting their participation in research exacerbates existing disparities (Erves et. al, 2017). Past research highlights a concerning lack of representation from racial/ethnic minorities in adults with serious mental illness (Cabassa et. al, 2010). To address healthcare access, health literacy, and implications of the prevalence of mental disorders among underrepresented populations in biomedical research (UBR), the All of Us Research Program (AoURP) aims to capture the influence of biology, lifestyle, and environment for better preventive care and individualized treatment. UBR participants are over 66 years old, non-white, and with less than a high school diploma. Represented in Biomedical Populations (RBR) are 18 to 65 years old, White, and with at least a high school diploma. Data was compiled from Overall Health and Healthcare Access & Utilization surveys and electronic health records.

Presenting author: Sharon Song

Poster 30


Background: There are currently no pediatric cardiologists at Buganda Medical Center (BMC) in Mwanza, Tanzania, despite a large burden of congenital and acquired heart disease in children. The pediatric residents are the front-line, in-patient and out-patient cardiology providers without subspecialty expertise, and limited access to focused education in pediatric echocardiography. Methods: The target group was BMC pediatric residents in year 2 and 3 of pediatric residency who participated in the pediatric echocardiographic workshop. We conducted a baseline comfort survey in performing and interpreting echocardiograms and a pretest in echocardiography knowledge. This was followed by an in-person, 5-day, hands-on, echocardiography workshop with focus on obtaining basic pediatric 2-dimensional echo images from five imaging planes and the ability to recognize abnormal pediatric echo images from these imaging planes. A post skill test was performed to assess each resident's ability to perform an echo by obtaining a standard echo image from each imaging plane, and a posttest given to assess their interpretation skills by being able to recognize normal vs. abnormal echocardiographic images.

Presenting author: Shivani G. Patel

Poster 31

Describing Prehospital Care of Trauma Patients Presenting to the ED at Bugando Medical Center Over 6 Months

Introduction: Trauma is a major cause of morbidity and mortality worldwide and in Tanzania. It causes 4.7 million deaths globally, with more than half of those deaths taking place in low- and middle-income countries.1 Most trauma-related fatalities take place during the prehospital period – at the accident site or en route to a facility.2 Understanding the types of trauma patients, injuries, where and how injuries occur can help improve outcomes and target out-of-hospital-interventions. Bugando Medical Center (BMC) is a large tertiary referral hospital in Mwanza, Tanzania serving a catchment area of 9,000,000 people. Prior to this study, the proportion of trauma patients presenting for care was not known and there was no standard documentation of pre-hospital or trauma care. There is a standard trauma data form from the World Health Organization (WHO) which has been implemented in another Tanzanian hospital. This study aims to build off the long-standing partnership between Lurie Children's Hospital and Bugando Medical Center to start a trauma registry and implement a standard data collection mechanism for trauma patients to guide future interventions.

Presenting author: Sophie Breedveld

Poster 32

A Systematic Review of Epilepsy Surgery in Low and Low Middle-Income Countries and a Proposed Program Framework

Background: The International Global Action Plan on Epilepsy and Other Neurological Disorders (IGAP) promotes the landscape of epilepsy care worldwide over the next decade. Disadvantaged populations in low and low middle-income countries (LMIC) currently lag years behind their high-income counterparts in access to surgical care. The objective of this study is to further characterize the state of surgery in these areas with relative paucity of healthcare resources. Methods: A systematic review among three databases (MEDLINE, Embase, and Scopus) were searched between inception to October 2023. Studies reporting surgical epilepsy programs in LMIC countries were included.

Presenting author: Sunny Abdelmageed

Poster 33

Terrorist Attacks in Latin America from 1970 through 2020: Analysis and Impact from a Counter-Terrorism Medicine Perspective

Terrorism has placed an enormous burden on several developing countries, including in Latin America. According to the global Terrorism Database (GTD), in 2020, there were nearly four times the number of terror attacks per year in Latin America than in 1970. Forced displacement of victims of terrorism has created social and economic challenges for the displaced home countries, transit countries, and their final destination. In Latin America, terrorist attacks have also had a significant increase in the number of asylum applications than other areas of the world. The purpose of this paper is to perform a retrospective descriptive analysis of terror events in Latin America from 1970 through 2020 utilizing the Global Terrorism Database (GTD) to inform perspective on the impact of terrorism in the region.

Presenting author: Timothy J. Curtis

Poster 34

East Asia and the Pacific Surveillance Metrics and History of the COVID-19 Pandemic: Updated Epidemiological Assessment

Background: This study updates the COVID-19 pandemic surveillance in East Asia and the Pacific we first conducted in 2020 with two additional years of data for the region. Objective: First, we measure whether there was an expansion or contraction of the pandemic in East Asia and the Pacific region when the World Health Organization (WHO) declared the end of the COVID-19 public health emergency of international concern on May 5, 2023. Second, we use dynamic and genomic surveillance methods to describe the dynamic history of the pandemic in the region and situate the window of the WHO declaration within the broader history. Third, we provide historical context for the course of the pandemic in East Asia and the Pacific. Methods: In addition to updates of traditional surveillance data and dynamic panel estimates from the original study Post et al. (2021), this study used data on sequenced SARS-CoV-2 variants from the Global Initiative on Sharing All Influenza Data (GISAID) to identify the appearance and duration of variants of concern. We used Nextclade nomenclature to collect clade designations from sequences and Pangolin nomenclature for lineage designations of SARS-CoV-2. Finally, we conducted a one-sided t-test for whether regional weekly speed was greater than an outbreak threshold of ten. We ran the test iteratively with six months of data across the sample period.

Presenting author: Yingxuan Liu

Poster 35

Tissue Specific DNA Methylation Based Biological Age Among Women with Breast Cancer in Mali

Background: Breast cancer (BC) is the most prevalent global cancer with higher mortality rates, particularly in developing countries. The West African region has the second highest mortality rate with an alarming prediction of a doubling in BC incidence across Africa by 2050. Of significant concern is the fact that BC affects women at much younger ages in the African region when compared to high-income countries. Despite the high mortality rate and expected increase in incidence, research regarding age-related epigenetic alterations and BC in this historically underrepresented population is scarce. Research Objective: We investigated the association between biological aging, as estimated from breast tissue DNA methylation and BC among women living in Mali. Methods: DNA methylation profiling was conducted on 21 women's breast tissue using MethylationEPIC BeadChip. Six biological aging metrics were estimated using an online calculator: Intrinsic Epigenetic Age Acceleration (IEAA), Extrinsic Epigenetic Age Acceleration (EEAA), Phenotypic Age Acceleration (PhenoAA), Grim Age Acceleration (GrimAA), skin and blood age acceleration (SBAA), and telomere length attrition (TLA). Principal component analysis was used to evaluate directionality and classification of breast tissue samples. Multiple linear regression analyzed the association between each biological age acceleration metric and breast tissue.

Presenting author: Zachary Heidrick

Poster 36